On-Line Membership

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Facilities & Healthcare Engineers Association

(FHEA)

PO Box 2649

Toledo, OH 43606

Copyright 2012 by Facilities & Healthcare Engineers Association All rights reserved.

FACILITIES & HEALTHCARE ENGINEERS ASSOCIATION

MEMBERSHIP APPLICATION

Last Name:

First Name:

MI:

Organization Name:

Address:

City:

State:

Zip Code:

Phone No.:

Fax No.:

Position/Title:

eMail:

Annual Dues:

$25.00 (STUDENT)

$50.00 (1 MEMBER)

$300.00 (UP TO 10 MEMBERS)

(include individual names in an email to Exec. Director)

$200.00 (UP TO 6 MEMBERS)

(include individual names in an email to Exec. Director)

Federal ID #34-1323555

DO NOT USE THIS ON-LINE FORM UNLESS YOU ARE PAYING BY CREDIT CARD

ON-LINE MEMBERSHIP FORM

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